The nurse cares for a patient recently diagnosed with chroni…

The nurse cares for a patient recently diagnosed with chronic obstructive pulmonary disease (COPD). The nurse obtains the following information from the patient’s health history: History of alpha-1 antitrypsin deficiency Smoker – 1 pack per day for 40 years. Prior occupational exposure to  asbestos.  Lives in a large city with exposure to air pollution, The nurse knows which factor most likely had the greatest impact on the development of COPD?